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A faulty production line

RCGP will ensure examiners are 'representative of race and ethnicity'

The RCGP has said it will prioritise ensuring that examiners for the MRCGP exam are ‘representative of the UK’s broad mix of race and ethnicity’.

The college also said it will work with training bodies to provide support for struggling candidates and those needing more exposure to UK culture and systems.

It today released its response to the written judgement from the recent judicial review on the differentials in pass rates between white UK graduates and international medical graduates and non-white UK graduates.  

Dr Maureen Baker, the chair of the RCGP, also said the college is involved in ‘ongoing dialogue’ with the British Association of Physicians of Indian Origin, who instigated the judicial review.

Mr Justice Mitting released his written judgement, which found that the exam was lawful, but said ‘the time has come’ for the RCGP to act on the issue.

In a statement in response to the written judgement, the RCGP said: ‘[We will] work closely with deaneries, local education and training boards (LETBs) and other associated organisations, to address training quality standards and to provide support for struggling candidates and those who need more exposure to UK culture and systems; develop examiner panel profiles that are fully representative of UK doctors.’ 

RCGP chair Maureen Baker said the RCGP would take urgent action to implement the recommendations.

She said: ‘We welcome the written judgement and are in ongoing dialogue with BAPIO, the GMC and other relevant organisations as to how we can move forward. We are keen to work proactively on a number of areas to the benefit of patients and trainees, rather than simply on those that were raised in the Judicial Review.’

BAPIO president Dr Ramesh Mehta said: ‘It was hard work bringing the judicial review, and the result is disappointing. But I’m pleased that the RCGP has initiated dialogue with BAPIO to ensure that the CSA is fair, and not discriminatory against BME doctors.

‘The judge said he was satisfied that BAPIO brought the claim in good faith, and that it was in the public interest. There does seem a willingness by the RCGP and GMC to sort out this issue.’

Readers' comments (11)

  • Justice for CSA is not done by bringing more BME GPs as CSA examiners. RCGP Statistics shows BME examiners marked both the IMGs and local graduates harshly than the white local GP examiners. It should not be like that. All examiners must give a fair mark for all candidates which could be reproducible across the board regardless their colour, ethnicity or other protective characteristics. No one is asking to dumb down the exam or bring different as examiners. We only ask the exam to be fair and transparent. Simply as that!!

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  • Fully support above the comments. The requests of the doctors for two examiners in each station and for video records kept for access in appeal process are two simple but powerful changes which reassure the GP trainees.
    And give the 200 odd ejected trainees another chance at exams after training of up to a year.

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  • Agree with the above comments.
    Hopefully nice people will come in future, who will think professionally and believe in fairness.

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  • This is an interesting and timely article. Only today, I have received another email from the RCGP telling me that I am still on the waiting list to become a CSA examiner after over 18 months on the waiting list and expressing continual interest in the role.

    Diversity amongst examiners is less important than diversity in cases and making them more inner city real world scenarios. Where I work, it is common for a patient to respond with "you're the doctor" when asked about their expectations or to choose from a list of management options. These ethnically and socially diverse patients are not accurately reflected in the CSA exam so there is a real need for grass roots GP involvement in the development as well as marking of cases.

    I also agree with the above comments re calibration. I find it puzzling that stage 3 recruitment for general practice involves extensive calibration methods but the more important CSA exit exam does not.

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  • Vinci Ho

    This is a test of willingness and sincerity of the college to 'evolve' this examination with transparency . Continuous dialogue between BAPIO and RCGP is essential no matter what.
    Everybody should remember and respect every word in Justice Mitting's written judgement........

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  • Una Coales

    Training examiners and actors in E&D is NOT the same as testing them for unconscious bias. A BME examiner told me on April 17 that she had done the Harvard IAT online test for unconscious bias and came up ''moderate' preference for the white race!

    I spoke to Pauline Foreman, the new CSA chief examiner on April 17 at the BAPIO conference in Birmingham and she confirmed there will be NO videorecording of the CSA rooms for evidence for fair appeals, NO 2 examiners per station, and NO testing of the actors or examiners for unconscious bias.

    How may BME/IMGs be reassured they will face a fair exam if unconscious bias is NOT adequately controlled? How did it make a male Indian GP trainee who had managed to get into Cambridge to study medicine, pass all his Cambridge exams and final, complete 3 years as a GP trainee, feel to then have to sit a 4th CSA because the exam will not test for unconscious bias which has been acknowledged by the world to exist since at least 2007 and can now be tested for?

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  • Una Coales

    The only way to get the RCGP to agree to 2 examiners per CSA station (as they had for the oral module of the old MRCGP exam and offered 2 venues, London and Edinburgh) and to agree to videorecording each of the 39 CSA rooms for appeals (or offer the video module as an alternative as they used to offer simulated surgery as an alternative to the video module pre 2007), is if 10,000 BMEs/IMGs resigned membership of the RCGP. The loss of £5 million income a year would make them sit up and address the ICE of BMEs/IMGs with this exam immediately.

    If 1,000 BMEs/IMGs resigned the College, a loss of £500,000 of annual income would also cause them to respect BME/IMG members more and start to actively listen instead of impose.

    Newly qualified BMEs/IMGs are not aware that you do not need to pay the College to be a member to work as a GP once you have your CCT/CEGPR. You are put on the GMC GP register and NHS performer's list whether you are or are not a continuing member of the RCGP. You may use the Clarity toolkit to do your appraisals/revalidation.

    You only need to rejoin and pay for membership to obtain a certificate of good standing when you wish to emigrate to Australia or Canada and then convert to FRACGP.

    This is the same most powerful bargaining tool that NHS GP partners have at their disposal, if only they could open their eyes and see this as did the late Bob Crow who negotiated a £40k+ pay for train drivers with 6 months training to drive a tube train!

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  • I love the idea of 2 examiners per station and video recording and appeals, everyone seems to like that idea.

    But who is going to pay for it? I think it needs to come from the candidates, but I would have been cross if I had to pay an extra 1000 pounds or so for the exam.

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  • @ una coales -Is it really possible to completely eliminate ALL biases and prejudices? We are humans after all? If we tried to look for examiners/actors with absolutely no bias, we will be left with no one at all to conduct the exam apart from candidates!

    The fact is this; patients have their prejudices (some much more than others) a 'BME' I only know this too well..yes, whilst I agree with you that there should be 2 examiners on each station to try and minimise this as much as possible, it simply is not feasible in the real world to completely eliminate prejudice and perhaps part of the skill of being a good GP is to see beyond patient bias, be it related to their own health ideas, race of the doctor, expectations of what the NHS can deliver etc and to do the best we can for all our patients

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  • As one of the CSA victims I feel the College is making things worse. Personally I feel examiners from minor ethnic communities mark the IMGs much lower compare to white examiners. As an IMG I have the unshaken belief that if I had only white native examiners I would have been GP by now. It would be interesting if someone (like Prof Esmail) looked at this to see how those examiners marked IMGs compared to white examiners). There are many reasons why this happens. The only solution to this CSA problem which is harming, candidates,college itself, patients, taxpayers and the future of General Practice is as Una Coales says and I have been crying for it for ages is: Fairness by videorecording every station, and most importantly 2 EXAMINERS in the room no matter of their colour or ethnic origin. I would personally be willing to pay double fee or even more to have video recording and two examiners as this determines my career and ultimately the future. The introduction of more examiners from minor ethnic groups will make matters worse for IMGs and RCGP knows that that is why they are being so "generous".

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